Arthritis in the prehistoric Southeastern United States Biological and cultural variables.

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Arthritis in the Prehistoric Southeastern United States:
Biological and Cultural Variables
CHARLES HUDSON, RONALD BUTLER AND DENNIS SIKES
Department of Anthropology, Department of Veterinary Pathology,
University of Georgia, Athens, Georgia 30602
KEY WORDS
Arthritis
.
Erysipelothrix insidiosa
.
Prehistoric.
ABSTRACT
Recent research shows that a bacterial life form, Erysipelothtix
insidiosa, can produce rheumatoid arthritis in deer, swine, and dogs, and that a
number of animals, including man, birds, and fish, may be infected by the organism. Examination of the archaeological record suggests that both cultural
and biological variables may be interrelated in the maintenance of some forms
of arthritis over long periods of time in geographically disparate populations.
Re-examination of Cherokee folk beliefs concerning arthritis suggests that they
had some recognition of this connection, and it also suggests that the term
‘‘magical’’ may relate more to the world view of the observer than to any actual
inability of preliterate peoples to draw causal relations on the basis of their own
intimate knowledge of their environments.
Arthritis in its several forms is among
the oldest known diseases afflicting vertebrates. The temporal range of arthritis extends from PZatecarpus, a swimming reptile of 100 million years ago (Hollander,
’62) to recent life forms. Documentation
of one or more forms of arthritis in populations of Homo include Neanderthal (La
Chapelle aux Saints), ancient Egyptian
nobility (Harris and Weeks, ’73), and
numerous others (Brothwell, ’65; Wells,
’64, for a general overview). Despite its
prevalence in both recent and prehistoric
populations, however, arthritis has remained something of a mystery disease,
both in terms of causative factors, medical definition, and even diagnosis, especially diagnosis of skeletal material. And,
although archaeologists have unearthed
scores of burials showing the presence or
presumed presence of the arthritides, it
has not been understood how the disease
is maintained and how it has continued
over long periods of time in geographically
disparate populations.
We have examined the problem in a
single area, the aboriginal Southeastern
United States, from two perspectives : one
focused on the belief system of the
Cherokee Indians fur the light it sheds on
AM. J. PHYS.ANTHROP.,43: 57-62.
cultural and ecological considerations of
arthritis, and the other on related biological factors such as causative factors and
disease transmission and maintenance.
The Cherokee Indians of the Southern
Appalachian Mountains held a number of
folk beliefs about arthritis. Their word for
both rheumatism and arthritis is didv.le.
hsgi, but arthritis is sometimes distinguished a s udhu-n didu.le-hsgi, where
udhv.n means “big.” The word literally
means “it breaks them,” evidently alluding
to the fact that the pain of arthritis is like
that of a broken bone (King, ’74). One of
the central tenets of the Cherokee theory
of medicine is that a fundamental enmity
exists between man and animals: m a n kills
animals for food, and sometimes he kills
animals carelessly; i n revenge, the animals
afflict m a n with various illnesses (Mooney,
’00:250-252). Consistent with this, they
believed that the disease we might now
classify as one of the deforming and
crippling forms of arthritis was associated
with animals that “hump” their backs,
such as the bison, squirrel, rabbit, cat,
inchworm, sunfish, buffalo fish, and speckled trout. A person suffering from arthritis
was advised to abstain from eating the
flesh of these animals and, for the same
57
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C. HUDSON, R. BUTLER AND D. SIKES
reason, the sufferer was required to abstain
from petting dogs and cats (Mooney, ’32:
291-294). Conventional wisdom in anthropology tells us that this is homeopathic or
imitative magic: it is a superficial resemblance magnified into a causal connection.
The Cherokees also believed that arthritis could be caused by violating rules of
sexual behavior, particularly the crime of
incest (Mooney and Olbrechts, ’32: 196).
Here, too, anthropological theory gives us
a quick and ready answer. Namely, the belief that one can be afflicted by arthritis
a s a consequence of committing incest is
obviously magical and wrong-headed, but
it nevertheless serves society by having a
useful function: namely, it functions to
discourage incest and its attendant social
disruption, thus strengthening and perpetuating the social order.
The Cherokees believed in yet another
cause of arthritis: if a hunter killed a deer
without begging pardon of the deer’s spirit,
then the Little White Deer, the guardian
spirit of the deer species, would follow the
trail of blood to the hunter’s cabin to enter
him invisibly, afflicting him with crippling
arthritis (Mooney, ’00 : 250-251; Mooney
and Olbrechts, ’32: 205-208). Although anthropological theory cannot explain this
belief quite so readily as it can the other
two, a plausible explanation can be found.
That is, given the Cherokee assumption
that vengeful animals cause many of
man’s illnesses, it would make sense that
they would make a connection between
their most important game animal and one
of their most dreaded diseases.
Both archaeological and historical evidence attest to the paramount importance
of the white-tailed deer (Odocoileus virginianus) as a game animal for the Cherokees as well as for other Southeastern
Indians, both in the remote prehistoric
past and throughout the colonial period.
Arthritis was a particularly crushing affliction for the Cherokees. Until the coming
of European diseases such as smallpox, it
was perhaps the most feared of all illnesses, particularly for a man. In traditional Cherokee culture the ways in which
most men won the respect of their fellows
was in hunting, the stickball game (a form
of lacrosse), and warfare. All of these
pursuits required exceptional agility, dex-
terity, and endurance, which would have
been lessened or ruined by crippling arthritis. Thus, it can plausibly be argued that
the Cherokees did indeed make a magical
connection between (1) their most important game animal and ( 2 ) a dreaded
disease.
Biological and ecological variables
Recently, research by one of us (D.S.)
and associates in the Department of Veterinary Pathology at the University of
Georgia has suggested that while the language of this belief i n deer-caused arthritis
is poetic or “magical,” it may nevertheless
point to a valid biological causative factor.
The only known infectious agent which
has been proved to produce rheumatoid
arthritis in deer, swine, and dogs is a bacterial life form, Erysipelothrix insidiosa a n
organism widespread in nature which infects a variety of animals, including man,
birds, and fish (Sikes, ’67, ’68, ’69b). The
relationship between the organism and the
more severe form of arthritis i n Homo
sapiens remains to be demonstrated fully,
but positive serologic tests have been recorded in the blood serum of human
patients suffering from rheumatoid arthritis, suggesting strongly that these individuals had been exposed to the organism
(Sikes et al., ’72). The suggested relationship is reinforced by experimental work
i n which rheumatoid arthritis has been
produced in swine infected with isolates
of E . insidiosa of human and porcine origins. Additionally, there are reported
cases of humans contracting arthritic
pathologies after handling infected animals and bones, although the specific etiologic agent in these cases was unknown
(Sikes et al., ’56).
In white-tailed deer experimentally injected with E. insidiosa, all innoculated
deer joints develop acute arthritis which
spreads to other joints, becomes chronic,
and persists. Innoculated animals exhibit
periods of clinical remissions and exacerbations just as they occur in man. During
periods of exacerbation, the severity of the
lameness increases in cold, damp weather
(Sikes et al., ’56). I n all cases, pathologic
tissue changes in the joints of arthritic
deer are similar to those in man and swine
with rheumatoid arthritis, and the same
I
ARTHRITIDES
basic pathogenesis may be operative in all
these species (Sikes, ’69a).
I n a recent experiment, approximately
30% of a sample of wild white-tailed
deer from the Southeastern United States
showed low titers to the Erysipelothrix
tube test (Sikes et al., ’72). This suggests
that some members of this deer population
are potential sources of infection which
may produce arthritis. Notably, the clinical
manifestation of ankylosing spondylitis i n
some deer specimens is grossly and histologically indistinguishable from the same
manifestations i n man. The variety of arthritis in question also is referred to variously as Marie-Strumpell’s disease, bamboo
spine, or poker spine. All involve varying
degrees of calcification of ligaments, ranging from the sacroiliac articulations and a
few vertebrae to advanced bony fusion of
the spine.
Evidence of arthritis in the prehistoric
Southeastern United States
According t o the work of a large number of researchers, the archaeological record for the southeastern portion of North
America shows a high incidence of what
has been interpreted a s arthritic afflictions
i n man, a record ranging from very early
times up to historic populations. Further,
there are few, if any, sites in this area
which do not show a high incidence of
deer bone a s well. In excavating the
Stanfield-Worley Bluff shelter in Colbert
County, Alabama, DeJarnette, Kurjack, and
Cambron (’62) encountered a high incidence of white-tailed deer remains, with
some dating to 5,000 years before the present. Much of the deer bone from this site
seems to have been broken intentionally,
probably to obtain marrow, and the frequency of recovered bone suggests that the
white-tailed deer was the basic meat staple.
Fragmentary human remains representing
13 individuals were recovered, and, of
these, two males and one female show
bone pathologies attributed to arthritis.
W. D. Funkhouser, reporting on human
material from the same general geographical area, observes :
“One of the commonest of all types of
malformations found in the Alabama material is the fusing of the vertebrae. This
condition is perhaps most often noted in
59
the lumbar region, but may be found in any
part of the spinal column . . . Such conditions of the vertebrae are usually assumed
to indicate some form of arthritis or rheumatism, and, if so, a large number of the
aborigines must have suffered from these
diseases.” (Webb, ’39: 124.)
Marshall T. Newman and Charles E.
Snow came to much the same conclusion
in their evaluation of human skeletal material from the Pickwick Basin, a n area
encompassing adjacent portions of Alabama, Mississippi, and Tennessee (Webb
and DeJarnette, ’42: 467) :
“The most common affliction of the Pickwick Basin population seems to have been
arthritis. This is most usually manifested
in hypertrophic form i n the lumbar vertebrae, and in arthritic changes in the sacra.
The incidence of arthritic invasions of the
lumbar vertebrae was about double that of
the cervical vertebrae, while the thoracic
seems to be unaffected. Arthritic ankylosis
is present in the lumbar vertebrae of three
skeletons.”
About one-third to one-half of a n adult
sample from Moundville, Alabama, were
afflicted with hypertrophic arthritis in the
lumbar region and show some evidence of
what has been interpreted as arthritic
pathologies in other parts of the skeleton
(Snow, ’41). In another report dealing
with material from Norris Basin in East
Tennessee, W. C. Funkhouser reports, perhaps with a dash of black humor, on one
male of advanced years whose infirmities
are rather pronounced :
“This old man must have been in bad
physical condition since practically all of
his skeleton shows some pathological condition, His lumbar vertebrae are fused and
lipped, bone destruction is evident i n the
femora, radii, innominate, and wrist bones,
fusing has occurred in the bones of the hand,
extensive periostitis has involved most of the
base of the skull, and some sort of osteomyelitis has completely destroyed the left
acetabulum and the head of the left femur.
In addition, he had a bad case of pyorrhea,
with a n excess of bony deposit on the mandible; he had three large molar cavities and
his skull was deformed. Aside from this,
he was apparently all right - so far as his
bones were concerned.” (Webb, ’38: 233).
Evidence of what might have been
arthritic pathologies also is found in the
Hiwassie Island excavations (Lewis and
Kneberg, ’46), from the Sours Site in Virginia (MacCord, ’SS), and from Citico on
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C. HUDSON, R. BUTLER AND D. SIKES
the Little Tennessee River (Salo, ’69).
Additionally, personal observation by one
of the authors (R. B.) confirms what
seems to have been severe forms of the
arthritides in remains from Indian Knoll,
an Archaic site, from the Little Egypt site
imnorth Georgia, a site with at least two
components (1300-1400 A.D. and 15001700 A. D . ) , and from St. Catherine’s
Island, Georgia. The latter site dates to
about the 12th Century A. D. by the radiocarbon method. Deer bone is prevalent in
both Little Egypt and St. Catherine’s
Island.
These sites do not exhaust the available
reports from the Southeast, but, so far as
physical anthropology is concerned, they
are representative of the area. In fact, we
think it would be difficult to find any excavation in the Southeast with good skeletal
preservation where evidence of arthritis is
not found.
DISCUSSION
It must be stressed that the evidence
concerning the frequency of deer bone and
skeletal pathology interpreted as arthritis
in the prehistoric Southeast is not intended
as proof of a one-to-one correlation between Odocoileus uirginianus and the presence of the disease. In fact, the data now
available suggest a much more complex
ecological problem, compounded by the
fact that diagnosis of the arthritides from
skeletal populations is not a simple and
clear-cut process. Other mammals, birds,
and fish carry or may be infected by
E . insidiosa. Consequently, there are several hypothetical ways in which the organism might be transmitted to man. The
most obvious manner would seem to be
through the dressing and handling of infected game prior to cooking, which destroys the organism. Ways in which food
is prepared are, of course, culturally determined, as are food preferences. Further, there is the problem of how division
of labor is assigned within a given culture;
that is, males may be responsible for the
kill, but there may be a wide range of
alternatives available as to who dresses
game, or whether uncooked game is handled for ritual or distribution purposes
prior to cooking. Other cultural variables,
a s well, may be intricately interrelated
I
with biological factors. Most, if not all,
cultures have rules of avoidance which
impose taboos on certain types of foods,
and which further impose food sanctions
during various periods of crisis, as in
pregnancy, menarche, preparation for initiation, preparation for war, and so forth.
These factors might impose culturallydetermined limitations on the probability
of exposure to E . insidiosa within specific
age and sex categories in a given culture.
Aside from exposure to the organism
through direct contact with infected life
forms, there also exists the possibility that
bird or mammal feces may be responsible
for transmitting the disease, and even that
other life forms may acquire the organism
through exposure to human waste material, as for example, near or in natural
water sources, The manner in which undesirable animal parts are disposed of may
also be a variable, perhaps in setting up a
potential for infection in animals which
feed on the waste. Whatever the precise
nature of all these possible relationships,
the antiquity and widespread geographical
nature of arthritis suggests a rather complex nexus of variables in which culture
plays a major role in maintaining the disease over a long period of time. In our consideration of the arthritides, we have
focused on the severe, deforming varieties
of the disease and have not included such
pathologies as “osteoarthritis,” which may
or may not be the result of continued
trauma and skeletal stresses over the lifetime of a n individual (for a discussion of
prehistoric “osteophytosis” see Chapman,
’73).
Turning now to cultural considerations,
these findings raise the possibility that the
concept of magic is both ethnocentric and
deleterious to a systematic advance of
knowledge about man’s ways. If a belief
or practice from another culture does not
seem reasonable or efficacious with respect
to our own world view, we typically declare that it is “magical;” then we search
our stock of theories for some sort of “explanation.” Once this is done, we dismiss
the belief or practice from further investigation, But the Cherokee belief that arthritis can be caused by a Little White Deer
shows that valid knowledge based on extensive observation can be stated in a n
61
ARTHRITIDES
exotic idiom (Horton, ’67: 53-58). The
Cherokees and their ancestors hunted the
white-tailed deer for thousands of years,
and it is not difficult to see how it was
that they noted a connection between exposure to deer carcasses and the disease
we call arthritis, The Cherokees perhaps
had some understanding of the causative
factors in arthritis long ago, but because
they phrased this understanding in the
idiom of their own world view, we labeled
it as magical and ruled it out of all serious
consideration.
At this point we may ask to what extent our concept of magic leads us to
ignore valid knowledge and testable hypotheses in other cultures, assuming all the
while that we have explained them. There
is no simple solution to this problem.
Instead of banishing all folk beliefs to the
realm of magic, where we pay no further
attention to them, we could adopt the view
that all folk beliefs are scientific until
proven magical. But this would be a n overreaction. Some of the beliefs and practices
of people in other cultures are erroneous;
some of them are erroneous even when
they follow logically from assumptions in
the world view of the people who hold
them (Wilson, ’71). Hence, if we simply
banished the word magic from our vocabulary we would have to devise another
word to cover the same territory.
There is no easy way out. One solution
might be that we retain our concept of
magic, but only on the condition that we
use it with the humility that comes from
the realization that we do not have a
monopoly on knowledge. In this way we
would be conscious of the fact that “magic”
refers both to beliefs and practices which
are erroneous with respect to what we
know, and do not work, and also to beliefs
and practices which are not erroneous, and
do work, but for reasons which are not
clear to us because of our limited knowledge.
With this in mind, let us look at another
example of magic. The Cherokees treated
arthritis with various forms of ritual treatment, but also by giving the patient decoctions made from fern fronds. A Cherokee
doctor explained to James Mooney that
“the fronds of the young fern are coiled up,
but unroll and straighten out as the plant
grows;” therefore, a decoction of ferns will
give the rheumatic (arthritic) patient the
power to straighten out the contracted muscles of his limb (Mooney and Olbrechts,
’32: 53-54). Should we conclude that this
use of ferns is yet another example of
homeopathic or imitative magic and let it
go at that?
From the biological perspective, we feel
justified in resorting to the hoary ritualistic commentary to the effect that much
more remains to be done in clarifying the
many interchangeable and inconclusive
terms used in defining arthritis and its
various manifestations. While we do not
detract from the efforts of earlier workers,
it is obvious that many of them use the
term “arthritis” in a vague manner and
usually without giving the bases for their
diagnoses. Some of the diagnoses may
prove to be incorrect. We do feel that the
available data justify drawing a tentative
causal relationship between E. insidiosa
and rheumatoid arthritis, and possibly between the organism and the variety of
arthritis known as Marie-Strumpell’s disease, although there may be other, possibly interrelated etiologies as well. For the
time being, there seems to be no reason to
attempt direct relationships with so-called
osteoarthritis. Finally, we feel justified in
suggesting a n integrated attempt to set up
biological guidelines for the interpretation
of arthritic pathologies in skeletal material,
including other vertebrate remains.
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